Metformin May Reduce Your Risk of Death from COVID-19 Infection

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

The use of metformin – the most common initial medication for people with type 2 diabetes – was associated with a lower rate of mortality from COVID-19 among people with diabetes in a study in Alabama, confirming five previous studies.

Do you take metformin? It’s the first-line therapy used to lower glucose levels in people with type 2 diabetes. A recent study found that metformin use was associated with a lower rate of COVID-related death among people with type 2 diabetes. Since people with diabetes are at increased risk for severe illness from COVID-19, including hospitalization and death, the relationship between metformin and COVID outcomes in this report may be of interest to many people around the world who take the medication.

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The study looked at the electronic health data from 25,326 people tested for COVID at Birmingham Hospital in Alabama, including healthcare workers, between February and June of 2020. Of those tested, 604 people were positive for COVID-19 – and 239 of those who were positive had diabetes. These results showed that the odds of testing positive for COVID were significantly higher for people, particularly Black people, with certain pre-existing conditions, including diabetes. This does not mean people with diabetes are more likely to get COVID-19, only that people with diabetes were more likely to test positive at this hospital.

Importantly, the study found an association between metformin use and risk of death – the study reported that people who were on metformin before being diagnosed with COVID-19 had a significantly lower chance of dying:

  • People taking metformin had an 11% mortality (or death) rate, compared to 24% for those with type 2 diabetes not on metformin when admitted to the hospital.
  • This benefit of metformin remained even when people with type 2 diabetes and kidney disease or chronic heart failure were excluded from the calculations. This is important because people with kidney or heart disease are often advised against taking metformin. By removing this population, it helps to support the notion that metformin may be involved in this difference.
  • Body weight and A1C were not associated with mortality among people with diabetes taking metformin. This suggests that the association of metformin use with reduced COVID-related deaths was not due to the effects of the medication on weight or glucose management.

The data suggest that being a person with diabetes who takes metformin may provide some level of protection against severe COVID-19 infection among people with diabetes. Other studies have shown similar results, though it is not known whether metformin may itself reduce COVID-related deaths among people with type 2 diabetes. The authors discussed some previously reported effects of metformin beyond lowering glucose levels, such as reducing high levels of inflammation (the body’s natural way of fighting infection), which has been described as a risk factor in severe COVID infection. Severe infection with COVID-19, resulting in hospital admission, can lead to damage to the kidneys and decreased oxygen supply to the body’s tissues – and in these circumstances, serious side effects of metformin can occur.

“Given that COVID leads to higher mortality rates and more complicated hospital courses in people with diabetes, it is important to consider whether specific diabetes medications can provide some relative degree of protection against poor COVID outcomes,” said Dr. Tim Garvey, an endocrinologist at the University of Alabama at Birmingham. “This study adds to growing evidence that people with type 2 diabetes treated with metformin have better outcomes than those not receiving metformin.”

Dr. Garvey also cautioned: “Of course, these case-control studies show associations and do not rise to the level of evidence that might be found by a randomized clinical trial. For example, people with diabetes not treated with the first-line drug, metformin, may have a larger number of diabetes complications or longer duration of disease compared with people not on metformin – which could explain the more severe outcomes. In any event, we advocate for early administration of COVID-19 vaccines and other protective measures for people with diabetes.”

Professor Philip Home, a professor of diabetes medicine at Newcastle University in the UK, agreed, saying, “Multiple studies have now addressed the issue of whether metformin and insulin use are associated with better or worse outcomes in people with diabetes who contract COVID-19. In line with previous literature on other diseases, it was expected that people on metformin would do better, and people on insulin worse, than people with diabetes not using these medications. This is confirmed.”

Home continued: “It is believed to happen because people using metformin are younger and have better kidney function than those not taking the medication, while those on insulin tend to have other medical conditions. The good news is that if you have type 2 diabetes and are taking metformin, you are likely to be fitter than if you have type 2 diabetes and do not take the medication – but there is no evidence that metformin itself will make a difference to your outcome if you do get COVID-19. So, get vaccinated as soon as possible!”

To learn more about metformin, read “Everything You Always Wanted to Know About Metformin, But Were Afraid to Ask.”

Source: diabetesdaily.com

Keto Nutella Fat Bombs

This content originally appeared here. Republished with permission.

Fat bombs are bite-sized snacks that are sugar-free, very low in carbohydrates, and high in fat, and they can be sweet or savory. They’re usually designed to help keep you in ketosis, but you don’t have to be in ketosis to enjoy fat bombs. Our bodies need fat to thrive, so there’s an easy Paleo-friendly adaptation included below.

And what better way to enjoy a fat bomb than with the famous flavors of Nutella! Nutty, earthy, and distinct hazelnut flavor paired with rich chocolate are what give Nutella its nutella-ness, and those foods are both keto and Paleo-friendly. Just add some creamy coconut oil and whatever sweetener you prefer, depending on if you’d prefer to keep it keto or Paleo, and you’re in business!

This dessert is gluten-free, grain-free, and refined sugar-free. So no matter who you’re cooking for, there’s something for everyone to love!

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Keto Nutella Fat Bombs

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Made in the blender with just four ingredients, these are the perfect no-bake treat or dessert!
Course Dessert
Cuisine American
Keyword fat bombs, nutella
Prep Time 10 minutes
Resting Time 30 minutes
Total Time 40 minutes
Servings 12 servings
Calories 182kcal

Equipment

  • High speed blender or food processor

Ingredients

  • 1 cup hazelnut butter
  • 1/3 cup coconut oil
  • 1/4 cup cocoa powder or substitute cacao powder + 1/4 tsp. vanilla extract
  • 3 – 3.5 tbsp monk fruit sweetener swerve (erythritol), or xylotol, or substitute any Paleo or Keto friendly sweetener of choice – see notes below for more options.
  • 1/2 tsp flakey sea salt optional
  • 1 tbsp chopped hazelnuts optional

Instructions

  • Add all ingredients to a high speed blender or food processor. Blend until completely smooth.
  • Pour the mixture into 12 lined muffin cups and transfer to the refrigerator. If you aren’t using muffin cups, transfer the mixture to a bowl and set in the refrigerator.
  • Allow the fat bombs to chill for at least 30 minutes. Remove the fat bombs from the muffin cups or scoop from the bowl into small 1-2 inch balls. Sprinkle with flakey sea salt and hazelnuts, if using. Keep chilled in the refrigerator or freezer until you're ready to serve, and enjoy!

Notes

Keto-friendly sweetener substitutions: 1/4 tsp liquid stevia.

Paleo sweetener options: 4 dates, 4 tablespoons maple syrup, or 4 tablespoons agave.

To store: Transfer to an airtight container and store in the refrigerator for 2-4 weeks or freezer for 1-2 months. Keep chilled until serving.

Nutrition

Calories: 182kcal | Carbohydrates: 4g | Protein: 3g | Fat: 18g | Saturated Fat: 6g | Sodium: 1mg | Potassium: 163mg | Fiber: 3g | Sugar: 1g | Vitamin C: 1mg | Calcium: 25mg | Iron: 1mg


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Keto Nutella Fat Bombs Recipe

Source: diabetesdaily.com

Rare Until It Happens to You: The Kycie Terry Story

This content originally appeared on Beyond Type 1. Republished with permission.

By Jordan Jendricks

Jamie Terry doesn’t know what exactly it is about her daughter that resonates so deeply with people. But there’s something about the combination of her curly blond hair, striking blue eyes, and the circumstances around her unfortunate and preventable death that have incredible staying power, inspiring countless others to action.

“There have been many times that I’ve thought about that. There are sick children all over the world, why Kycie? But there’s something about her and I truly believe she was here on a mission. She’s still on a mission. I just think there’s a reason behind it all.”

Because even now, five years after her tragic passing, strangers from around the world still reach out to the Terry family about their little girl. They remember Kycie and her story, which has reached thousands and saved an untold number of lives. Kycie’s father, Josh, has lost count of how many other parents have thanked him, explaining they, too, might have lost a child if not for his daughter’s story.

“I don’t know why it went as viral as it did. I think she just has a face, too. And you can see how heartbreaking it was and how hard she worked to try and get back. If you lose a child or you lose a family member, to think that they died for nothing, it’s that much harder. To know that she’s made a difference in other people’s lives and helped save other people’s lives, and saved a lot of heartache and struggles, it’s more doable.”

Kycie Jai Terry was the second youngest of six children and the only girl. After four boys, Jamie remembers crying tears of joy over her fifth ultrasound and the realization she would finally have a little girl. She remembers her daughter as a vibrant child, who loved to dress up, ride bikes and catch lizards; who was a little bit of everything and unique, as her name suggests.

“I don’t think I realized at that time, but now I think there’s a reason that she has this unique name because you Google her and she pops up and it’s because she needed to make a difference in the world.”

Where Things Went Wrong

Kycie

Image source: Beyond Type 1

Kycie was diagnosed with type 1 diabetes on January 30th, 2015 while in DKA (diabetic ketoacidosis). Where her story differs from many who live with undiagnosed type 1 and go into DKA is that she ultimately experienced cerebral edema, a condition where fluid builds up around the brain, causing pressure and swelling. This complication was occurring unbeknownst to the healthcare providers treating her at the time, wreaking havoc on Kycie’s brain and nervous system as she slept in her ER room bed. Less than 1% of pediatric patients in DKA experience cerebral edema, making it rare, though this statistic was of little comfort to the Terry family. As Josh puts it, “It’s always rare until it happens to you.”

As he recalls, Kycie’s initial symptoms started with a headache, then a stomachache. It seemed like she might have had a stomach flu, then strep. But she didn’t get better with antibiotics; in fact, she worsened. She didn’t want to eat, she only wanted fluids, and she was suddenly remarkably skinny. The Terrys felt an urgency to take their daughter to the hospital as her condition only seemed to get worse. She was extremely lethargic once there, and Josh recalls her fruity breath, a tell-tale sign of ketones. Sure enough, the doctor quickly revealed the cause of the problem: “She has type 1 diabetes.”

But Kycie’s blood sugar was difficult to control. Later, the Terrys would learn that during this time in the ER, doctors were focusing solely on treating her diabetes without realizing that she had experienced any brain damage, or that it was growing worse. With blood sugar readings over 1,100 mg/dl (61 mmol/L), Kycie was in severe DKA and needed to be life-flighted to a children’s hospital five hours away. After landing, she suffered a seizure on the ambulance ride from the airport to the hospital. Four hours later, she was intubated, on a ventilator, unresponsive and in a diabetic coma.

An MRI was completed after Kycie was in a coma for over 24 hours, revealing for the first time the cerebral edema. Doctors told the Terrys that they didn’t expect her to live, but Kycie fought, ultimately coming to breathe again on her own before waking up. She spent the next 111 days in the hospital to relearn basic functions, after which she was able to go home and live with her family for another month and a half, though her life was entirely different. It was suddenly a feat for the five-year-old to hold her own head up, smile, or roll over by herself. Josh remembers feeling torn and heartbroken to see his daughter’s life suddenly so difficult.

“I remember sitting up there and thinking what a horrible situation she was in – a situation I wouldn’t want to be in. If I was in that place, I wouldn’t want to live that life,” he shares. “At the same time, she’s my little girl and it’s my job to protect her and my job to be there for her. It was a really hard place to be.”

Kycie

Image source: Beyond Type 1

The family continued on, taking care of their daughter and treasuring the few good times during otherwise long days. They documented their new normal, sharing feel-good moments and milestones on social media.

Kycie then caught a virus that led to pneumonia and another hospitalization, setting back some of her progress and making her less responsive. Though she was able to return home after growing stronger, in the early morning hours of July 11th, her oxygen levels were extremely low and her parents were poised to take her to the hospital yet again. Before they could leave the house, the second youngest Terry passed away peacefully in her father’s arms. She was a few months shy of her sixth birthday.

Her Legacy Lives On

Kycie is well-known now in the diabetes community, her story having touched so many all over the world. Beyond Type 1’s Warning Signs Awareness Campaign, which began in 2016, was inspired by her story and the reality that both misdiagnosis and missed diagnoses are problems that can be solved through education and awareness. Josh and Jamie both can’t underscore enough the importance of being able to recognize the signs and symptoms of type 1 diabetes.

“To get an early diagnosis is so critical. If you can catch type 1 before DKA, you’ve saved yourself the possibility of brain damage,” Josh explains. “And so that early recognition is so vital, not just because of the scariness of DKA, but because of the unknown that comes with it.”

Jamie reflects on her own lack of knowledge about diabetes in general and how Kycie’s situation truly opened her eyes to a chronic illness that affects so many on a daily basis.

“I knew nothing about it. And the thing that’s crazy with Kycie is it all happened so fast. Within five days, she had a traumatic brain injury,” she explains.

Jamie sympathizes with everyone who manages type 1 diabetes, having gotten a small taste of the complexity of the disease while caring for Kycie’s type 1 diabetes (T1D) the short time she was able: “That’s what is heartbreaking to me. Anyone that ever comes up to me and tells me they have type 1, the first thing I say to them is ‘I’m so sorry’ because it’s so much to take on. And we didn’t even get to.”

The Terry family now advocates for safe and early diagnoses of type 1 diabetes, sharing about Kycie whenever they can and working with local hospitals to help improve type 1 protocols. In Josh’s practice as an optometrist, he lectures others in his field on type 1 and the importance of recognizing changes in vision as potential signs. Their family is continually touched by the outpouring of love for their little girl and all they’ve been through, the community they’ve found through their loss and the surprising amount of good that has come out of an otherwise tragic situation.

As Jamie puts it, “There’s no greater title than ‘Kycie’s mom.’ It will always be hard to live without her, but part of the healing journey has been to know that she has saved and continues to save lives.”

Source: diabetesdaily.com

Study Compares MiniMed 780G and MiniMed 670G Algorithms

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

A new study in adolescents and young adults with type 1 diabetes directly compared two automated insulin delivery algorithms. Medtronic’s newer Advanced Hybrid Closed Loop (built into the MiniMed 780G system) improved glucose management more than the MiniMed 670G, though both systems showed impressive increases in Time in Range for this population. Ultimately, the 670G gave users over an hour and a half more time in range each day, while the 780G gave wearers over two hours every day in range!

Two Medtronic automated insulin delivery algorithms, the Advanced Hybrid Closed Loop and the MiniMed 670G, were recently compared in a cross-over study, allowing 113 participants to use both algorithms. Results from the study were published in the medical journal The Lancet. Notably, the study tested this technology in adolescents and young adults with type 1 diabetes ­– a group for which diabetes management is notoriously challenging. View our resources for adolescents with diabetes here.

For an introduction to automated insulin delivery (AID), check out our piece on current and coming-soon AID systems in 2021.

What is the MiniMed 670G?

The MiniMed 670G is an AID system that has been available since spring 2017 – it was the first system ever to “close the loop.” The system includes the MiniMed 670G pump, the Guardian Sensor 3 continuous glucose monitor (CGM), and an automated insulin adjustment algorithm. The algorithm adjusts basal insulin delivery every five minutes based on CGM readings, and a target of 120 mg/dl.

What is Advanced Hybrid Closed Loop?

Advanced Hybrid Closed Loop (AHCL) is Medtronic’s next-generation AID algorithm. The AHCL algorithm is used in Medtronic’s MiniMed 780G system, which is currently available in at least twelve countries in Europe. While it is not yet available in the US, Medtronic hopes to launch the 780G in the US this spring. In addition to automatic basal rate adjustments, the AHCL algorithm can also deliver automatic correction boluses and has an adjustable glucose target that goes down to 100 mg/dl. This is big news because many people using closed loop do not want to target the higher 120 mg/dl, even as a safety measure. The 780G algorithm is designed to have fewer alarms and even simpler operation than the MiniMed 670G system.

What was the study?

The newly published FLAIR (Fuzzy Logic Automated Insulin Regulation) study was conducted over six months across seven diabetes centers (four in the US, two in Europe, and one in Israel). The study enrolled 113 adolescents and young adults (ages 14-29) with type 1 diabetes. The study sample is notable, because teens and young adults with type 1 diabetes have the highest average A1C levels of any age group.

At the beginning of the study, participants performed their usual diabetes management routine for two weeks to establish their baseline glucose levels. Half of the group was then randomly assigned to use the MiniMed 670G system, while the other half of the group used the same pump and CGM, but with the new AHCL algorithm. After three months – the halfway point of the study – the two groups “crossed over,” switching to the opposite technology.

What were the results?

Nearly every measure of glucose management favored the AHCL period over the MiniMed 670G:

  • Compared to baseline, participants reduced time spent above 180 mg/dl by 1.2 hours per day when using MiniMed 670G and 1.9 hours per day when using AHCL.
  • Time in Range (TIR, time between 70-180 mg/dl) improved from a baseline of 57% to 63% using Minimed 670G and to 67% using AHCL.
  • Time spent below 70 mg/dl fell 0.2% of the time. While those 28 minutes a day may not be statistically significant – and time in severe hypoglycemia, or below 54 mg/dl, did not increase from baseline when using either algorithm – many people with diabetes would benefit from that additional half hour in range.

The graph below shows the time spent in glucose ranges during baseline, MiniMed 670G, and AHCL periods. For both algorithms, the Time in Range increase from baseline was significant – use of either AID system led to at least 14 hours more each week spent in range. Nevertheless, we also point out, of course, that the group (again, the group that has the most challenges of any age group managing diabetes) still experienced a fair amount of time above 250 mg/dl. This is  another reason for healthcare professionals and people with diabetes to think about the “whole person” when considering diabetes management, and another reason why we always recommend Adam Brown’s Bright Spots and Landmines for ways to improve diabetes management in terms of food, exercise, mindset, and sleep – it includes many strategies for people, especially teens and young adults, to use each day.

AID comparison

Image source: diaTribe

  • The biggest Time in Range improvement came overnight (between midnight to 6am). During this six-hour overnight period, AHCL users spent an average of 4.4 hours in range (74% TIR), compared to 4.2 hours (70% TIR) for 670G, and 3.5 hours (58% TIR) during baseline. While the overnight Time in Range difference between AHCL and 670G may not seem large, it added up to nearly a 22-hour difference over the three-month the AHCL period.
  • With daytime numbers, the average AHCL user spent 63 more hours (about 2.6 days) in range than the average 670G user in each three-month study period.

The graph below shows daytime and nighttime differences in time spent in range (70-180 mg/dl), and the data is included in a table at the end of this article. Better sleep the night before can also make diabetes management more effective during the day.

Comparison

Image source: diaTribe

  • Using MiniMed 670G drove an average A1C improvement from 7.9% to 7.6%, while AHCL use improved A1C from 7.9% to 7.4%.

Both systems showed extremely positive results and were found to be safe for use in young people with type 1 diabetes. The AID algorithms led to dramatic increases in Time in Range in a population that stands to benefit – over the course of a year, adolescents and young adults could spend more than ten additional days in range. The direct comparison between these two AID algorithms is highly informative – we hope to see similar trials in the future.

Comparison

Image source: diaTribe

Source: diabetesdaily.com

Feta and Roasted Red Pepper Dip

This content originally appeared on ForGoodMeasure. Republished with permission.

In my humble opinion, picnics are ubiquitous with summer & no al fresco dining experience is complete without crisp, crunchy vegetables & an accompanying dip. Here’s one of our favorites. A simplified version of Greek Ktipiti, this recipe combines the briny tang of fresh feta with the sweet, slightly smokey undernote of roasted red bell peppers. Cutting the traditional heat allows the flavor of an accompanying crudités to shine through, although you could always jazz things up with a dash of hot sauce or pinch of red chili flakes.

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Feta & Roasted Red Pepper Dip

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This recipe combines the briny tang of fresh feta with the sweet, slightly smokey undernote of roasted red bell peppers.
Course Dip
Cuisine Greek
Calories 84kcal

Equipment

  • Food processor

Ingredients

  • 2 red bell peppers halved & seeded
  • 1 cup feta cheese crumbled
  • 2 tablespoons olive oil
  • 1 teaspoon garlic minced
  • teaspoon black pepper
  • teaspoon salt

Instructions

  • Preheat oven to 400 degrees.
  • Line a rimmed baking sheet with parchment.
  • Arrange halved peppers cut-side down on baking sheet.
  • Locate a glass or ceramic bowl large enough when inverted to cover the peppers, set aside.
  • Roast peppers for 40 minutes, until skins are soft & blackened.
  • Invert bowl over charred peppers, creating a steam bath.
  • After 15 minutes, remove the charred skins from the peppers.
  • Using the processor, combine the skinned peppers, feta cheese, olive oil, garlic, black pepper and salt, until thick and creamy.
  • Chill before serving.

Notes

Naturally low-carb & gluten-free.

Nutrition

Serving: 2tbsp | Calories: 84kcal | Carbohydrates: 2g | Protein: 3g | Fat: 8g | Cholesterol: 17mg | Sodium: 485mg | Fiber: 1g | Sugar: 1g


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

Feta and Roasted Red Pepper Dip Recipe

Source: diabetesdaily.com

The New Type 1 Diabetes Detection Program from JDRF

This content originally appeared on Beyond Type 1. Republished with permission.

By Stacey Simms

Stacey: Tell me more about T1detect.

Frank: T1Detect is an education and awareness program about type 1 diabetes(T1D) and its risks, and a very important component of that is making the [autoantibodies] test available to people. Because right now, they’re not really available to people except in the context of research settings, or as people like you might know, in the context of an actual T1D diagnosis, when someone has super high blood sugar, they’re in the hospital. Then the doctors will do a confirmation test to see if it’s type 1, we want to make it available to people who don’t yet have symptoms. So hence, T1Detect.

You can go and find the test in a couple of different places. First and foremost is the JDRF website, we have access to information and the test kit button on our website through T1Detect. You click the button, it gives you some information about what it is to have T1D, what the risk factors are, what are autoantibodies.

You click the button you go to the Enable portal, fill in some information, we’re asking for your name, mailing address, things like that. We’re also asking for some demographic information, we want to learn who’s getting to the end, who’s at risk, and that’ll help us improve the program going forward. Then you come to a choice where you can pay for the test, the test is not terribly expensive, it’s $55. To run the test, plus or minus a couple of taxes, you also have the option if you cannot afford the test to have JDRF [help] pay for the test and you will pay for the bulk of the cost.

Right now, it’s not a feature to ask your insurance company to pay for this, but in the future, it will be. All that being done, the test will get sent to you, you’ll get a little box in the mail. It was pretty simple, I did it. You have a Lancet, you poke your finger. Then you fill in two out of four of these circles on a piece of cardboard, let that dry, and send it back. A couple of weeks later, the company will tell you, you have one, two, or three of the type 1 diabetes-specific autoantibodies.

Stacey: What are you testing for?

Frank: Let’s take a little step back to the biology of type 1 diabetes, the biology of autoimmune diseases. Type 1 is an autoimmune disease, and one of the ways we can tell a person who has an autoimmune disease is we can look in their blood for signs and symptoms of that their immune system is doing something that it is not supposed to be doing. In type 1 diabetes, we look for something called autoantibodies.

Now autoantibodies are something that that’s sort of a general term to all different autoimmune diseases. People with multiple sclerosis have autoantibodies, people with lupus have autoantibodies. What we’re looking for in type 1 diabetes are autoantibodies that are specific to type 1 diabetes. What makes them specific to type 1 diabetes is they are specific to things that are in your pancreas. We actually are looking for three of the four primary autoantibodies that have been determined through many many years of research to be very good diagnostics for type 1 diabetes, they’re IAA [Anti-Insulin], IA2 and GAD65. Some people may remember those names from TrialNet or other organizations, but there are three of the four that help us diagnose to end and predict your risk…. Based on those three, if you have two or more of those, we know pretty well that your risk of developing insulin dependence is very, very high. In fact, if you have two or more of those in your blood, you already have type 1 diabetes… you may not be symptomatic, but you already have it.

Watch the full interview below:



Source: diabetesdaily.com

How Race and Ethnicity Affect Diabetes Prevalence, Management, and Complications

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney, Matthew Garza, and Eliza Skoler

Black, Indigenous, Hispanic, and Asian individuals, and people of all non-white racial and ethnic groups are more likely to have diabetes and diabetes-related health complications than their white peers. Here’s how social determinants of health lead to differences in diabetes care and outcomes, creating racial, ethnic, and economic health disparities in the United States.

According to the 2020 National Diabetes Statistics Report published by the Centers for Disease Control (CDC), diabetes affects over 34 million people in the United States – that’s more than one in ten people. However, diabetes does not affect all communities equally. As with many conditions – such as heart disease, chronic lung disease, and chronic kidney disease – a person’s race, ethnicity, and socioeconomic status influences both their risk for developing diabetes and their access to diabetes management resources. The health disparities that exist among the many races in the US are not attributable to genetics or biology alone, but also to socioeconomic factors and social determinants of health that disadvantage people of color.

Though genetics and biology do play important roles in diabetes prevalence and complication rates, this article will focus on the societal factors that affect the lives of people living with diabetes – such as access to healthy food, healthcare, employment, and other socioeconomic factors. We aim to specifically explore the racial health disparities that disadvantage communities of color. We will also highlight some of the factors underlying the concerning patterns in diabetes prevalence, management, and complications, and share ways to promote health and access to care for people with diabetes, regardless of race and ethnicity.

Defining Key Terms

  • Race & Ethnicity – Race is a socially constructed way to group individuals based on skin color and physical features. There is no specific set of genes that defines a race. Ethnicity is also socially constructed, and it categorizes people based on a shared sense of group membership (like language, culture, history, or geography).
  • Socioeconomic status – Socioeconomic status is a measure of a person’s economic and social standing. This term is often used interchangeably with social or economic class.
  • Health disparities – Health disparities are differences in health outcomes among various populations or communities. They are closely linked to social, economic, and environmental disadvantages that affect groups that have systematically experienced greater obstacles to health (due to factors including race, gender, age, sexual orientation, and economic status.)
  • Health equity – Health equity is the goal that every person, regardless of their background or circumstance, is able to live a healthy life with full access to quality healthcare and other health resources. Achievement of health equity requires valuing every person equally and addressing avoidable inequalities with focused, societal efforts to eliminate injustices and health disparities.
  • Social determinants of health – These are factors that influence a person’s health but fall outside the scope of a healthcare professional’s influence. They are the conditions in which people are born, grow, live, work, and age. For example, social determinants of health can include a person’s race, gender, socioeconomic status, education, and where they live and work; these factors are often longstanding and have multi-generational effects. Social determinants of health are one of the major causes of health inequities – the unfair and avoidable differences in health status.
  • Systemic racism – Also called institutional or structural racism, it is defined by systems and structures (such as medicine or the healthcare system) that have procedures or processes that disadvantage people of color.

Systemic racism lies at the center of this article. As we discuss racial health disparities and their underlying causes, keep in mind that these factors are a result of the long-standing structures that affect the lived experiences of people of color – they are not attributed to the personal decisions of individuals.

A Look at Racial Health Disparities in Diabetes

What do health disparities actually look like in the US? The data show concerning patterns: Black, Indigenous, Hispanic, and Asian populations are more heavily affected by diabetes than their non-Hispanic, white counterparts, in diagnoses, management challenges, and diabetes-related complications.

The CDC’s diabetes statistics report showed alarming differences among races in the estimated percentage of adults with diabetes (both diagnosed and undiagnosed) in the US from 2013 to 2016:

  • Black, non-Hispanic: 16.4%
  • Asian, non-Hispanic: 14.9%
  • Hispanic: 14.7%
  • White, non-Hispanic: 11.9%

While these differences in rates are stark, the evidence shows that diabetes prevalence is not dependent on race from a genetic or physiological standpoint alone. For example, in this study from 2007, when researchers accounted for socioeconomic factors, the differences in rates of type 2 diabetes between racial groups were reduced. This supports the idea that socioeconomic factors that disadvantage people of color are a significant cause for these health disparities.

In a 2017 study published in the Journal of Racial and Ethnic Health Disparities, a team of researchers from Meharry Medical College and Vanderbilt University found that there were differences in the quality of diabetes care between racial and ethnic groups. Using the 2013 Medical Expenditure Panel Survey (MEPS) data, they looked at adherence to five ADA-recommended services over one year that indicate quality of diabetes care. Compared to white individuals, Hispanic, Black, and Asian individuals received fewer diabetes management checks, including A1C tests, eye exams, foot exams, blood cholesterol tests, and flu vaccines. Even in adjusted models which controlled for factors like insurance coverage, poverty, and education, some of the disparities remained. Most notably, Hispanic, Black, and Asian individuals were still less likely to receive the two recommended annual A1C checks. The researchers showed that this difference in quality of care occurred partly because populations of color had less access to health insurance and diabetes management education, compared to white populations.

Trends in care translate to trends in diabetes outcomes – including complications and death rates. A study from 2014 looked into racial and ethnic differences in diabetes complications and mortality. Black, Indigenous, and Hispanic individuals had higher rates of retinopathyend-stage kidney disease, and amputations than non-Hispanic white individuals. Furthermore, these groups were more likely to die from diabetes than non-Hispanic white Americans:

  • Indigenous populations were 3 times more likely to die from diabetes
  • Non-Hispanic Black Americans were 2.3 times more likely to die from diabetes
  • Hispanic Americans were 1.5 times more likely to die from diabetes

Just as with the risk of diabetes, people of color are not genetically predisposed to diabetes-related complications due to race alone. A combination of social and environmental factors plays into a person’s ability to successfully manage their diabetes.

How Genetics and Biology Are Involved

Racial and ethnic categories are not as closely associated with genetics and biology as some people think. In fact, categories such as white, Black, Asian, and Hispanic are defined more by society than by any set of specific genes. However, to fully address the factors that affect diabetes prevalence and outcomes, we must understand the role of genetics and biology. Studies have shown that there are biological differences among races that correspond to how a person metabolizes (or utilizes) glucose, their insulin sensitivity, and how fat is distributed in the body – however, a person’s family history of diabetes is more telling of their genetic risk for that condition than the color of their skin. The research on how genetics, biology, and race all intersect and interact to influence diabetes is complex; there is still much to determine.

As discussed, genetics alone do not explain diabetes-related health disparities among the races. Furthermore, we cannot reduce the large health disparities by focusing solely on biological factors, which are largely predetermined; we must instead focus on the socioeconomic factors and social determinants of health that exacerbate racial disparities, which are in large part founded in longstanding systemic racism. Below we describe some of the many elements of systemic racism that affect a person’s ability to manage their diabetes and receive quality diabetes healthcare.

Main Causes of Racial Health Disparities in Diabetes Prevalence

The factors we discuss here are influenced by systemic racism that is built into the social, economic, and political fabric of the United States. The systemic racism that people of color experience results in things like lower wages, fewer academic and professional opportunities, and reduced community resources. With this in mind, factors like income, unemployment, health insurance, and food and exercise environments are not entirely personal choices, but can be explained by a number of external causes.

Income 

In the US, there are major racial differences in wealth. A 2018 Kaiser study offered this breakdown of people living below the federal poverty level:

  • 1 in 4 Indigenous people
  • 1 in 5 Black people
  • 1 in 5 Hispanic people
  • 1 in 10 white people

Further statistics on income and poverty levels can be found in the US Census Bureau’s 2019 report, which confirms the racial disparities in poverty rates. People living with incomes below the federal poverty level in 2018 were earning only $12,000 a year (or $25,000 for a family of four). These families – and many above the federal poverty level – often can’t afford the nutritious food, safe exercise opportunities, and healthcare needed to prevent and manage diabetes.

Unemployment and Health Insurance

People of color in America are also more likely to be unemployed. According to the US Bureau of Labor Statistics, the rates of unemployment in 2019, broken down by race, were:

  • 6.6% of Indigenous people
  • 6.1% of Black people
  • 3.9% of Latino and/or Hispanic people
  • 3.1% of white people

These unemployment rates and racial disparities have been further exacerbated by the COVID-19 pandemic, which dramatically increased unemployment rates in the US. Though unemployment is closely tied to income, it can also influence a person’s access to health insurance, since many people receive health insurance from an employer.

Stat

Image source: diaTribe

The high cost of healthcare means those who are uninsured or underinsured often do not get the care they need, including preventive healthcare (such as annual check-ups and prediabetes screenings) and instead must rely on inconsistent care. Unfortunately, Black, Indigenous, and Hispanic people are less likely to be insured in America. According to a Kaiser study of non-elderly individuals in the US, these were the rates of uninsured people in 2018:

  • 21.8% of Indigenous people (identified as American Indian or Alaskan Native
  • 19% of Hispanic people
  • 11.5% of Black people
  • 7.5% of white people

Food and Exercise

A healthy diet and regular exercise are known to reduce the risk and improve the outcomes of type 2 diabetes. However, Black, Hispanic, and Indigenous communities in the US have less access to healthy foods and experience higher rates of food insecurity than white communities. According to the USDA, more than 35 million people lived in food insecure households in the US in 2019, including:

  • 25% of Indigenous people
  • 19.1% of non-Hispanic, Black households
  • 15.6% of Hispanic households
  • 7.9% of non-Hispanic, white households

Food insecurity is most common among low-income communities, which are disproportionately occupied by people of color. Moreover, food deserts (where there is little to no access to healthy foods) and food swamps (full of unhealthy fast-food options) are located primarily in minority neighborhoods. These communities are often faced with local food options that put them at an increased risk for diabetes: more small grocery stores with limited choices, fast food restaurants, and liquor stores, and fewer supermarkets with fresh fruit and vegetable options, bakeries, and natural and whole foods.

In addition to less access to healthy and affordable food, people of color often also have less time, money, and overall access to venues for exercise. This article from the New York Times about the racially exclusive culture around jogging is an eye-opening example of the barriers to exercise that many Black people face. Even at a time when some of the world’s most elite runners are African or Black, Black runners and joggers (in America, especially) often engage in protective measures such as running only during the daytime, steering clear of certain neighborhoods, or wearing Ivy League sweatshirts to deflect any suspicions that could lead to racist attacks.

Main Causes of Racial Health Disparities in Diabetes-Related Health Complications

Barriers to healthcare (such as a lack of health insurance or insufficient income) continue after a person is diagnosed with diabetes. Without ongoing, regular diabetes care, people face higher rates of health complications. Here are some of the barriers:

  • The high cost of insulin has made the life-saving drug inaccessible to many people, including people of color who have higher rates of unemployment and little or no health insurance. An American Action Forum report showed that insulin costs a person an average of $6,000 per year and found that one in four people with diabetes report rationing their insulin because they cannot afford the cost of their full prescribed dose.
  • Despite major advances in diabetes technology that make diabetes management easier, including wider use of CGM and insulin pumps, disparities exist in who has access to these tools. Black individuals are less likely to use an insulin pump or CGM than their white counterparts – which may be due to failure of the healthcare professional to write a prescription for technology, insufficient information about diabetes technology, an inability to afford these devices, or subtle racism on the part of the established medical system.
  • Even for people who have insurance, the costs of diabetes care and a diabetes-friendly nutrition plan can be challenging for people with low incomes.

Social and racial barriers widen diabetes health disparities. There is a history of prejudice against people of color in our healthcare system: Black, Indigenous, and Hispanic individuals can have the same income, insurance, and medical condition as white people yet still receive lower quality care due to systemic racism. In 2018, fewer than 12% of practicing physicians in the United States were Black, Hispanic, or Indigenous individuals. This means that there are fewer healthcare professionals who can earn trust and identify with communities of color. For more information on racism in healthcare, check out Unequal Treatment.

The Importance of Addressing Health Inequity in Communities of Color

It is clear that the disparities in diabetes prevalence, care, and management can be explained in part by of a number of social determinants of health, many of which are influenced by systemic racism. Every person with diabetes faces health barriers. But for many, the color of their skin can make successful diabetes management even more difficult and sometimes impossible. Every person with diabetes should have access to diabetes care, medication, and technology, and to living a healthy life with diabetes.

What Can We, as a Society, Do to Reduce These Disparities?

It will take extensive, collaborative, and creative work to address these disparities. We can begin by educating ourselves and others. Some good first steps include learning about the challenges faced by people of color with diabetes, about the people working to address these issues already, and about the ways to get involved. Check out some of our other articles on these subjects:

At diaTribe, we want to acknowledge the people and the organizations at the local, state, and national levels who are already doing the work needed to effectively tackle the health inequalities that lead to higher rates of diabetes and less favorable outcomes among people of color. In addition to those whose jobs focus on addressing health disparities, there are other ways for people to be involved in promoting health equity. Here are some ideas to consider:

No matter what skills or resources you may have, determine how your expertise might be of benefit – particularly if you are in the health field where you can address systemic racism and health disparities. The more we learn about how the social determinants of health and racism in healthcare contribute to a person’s risk for diabetes and influence their diabetes management, the better prepared we’ll be to knock down barriers to quality care.

We acknowledge that every person should have the resources to manage their diabetes and, in the case of type 2 diabetes, to prevent it. All people, and especially people in positions of privilege, have a responsibility to help break down barriers to equal care for underserved communities. As people with diabetes and their allies, we have to do the work – and build upon the work already being done – to address racial health disparities and create more equitable and inclusive healthcare for people of color – in fact, for all of us.

Source: diabetesdaily.com

Low-Carb Turnips Au Gratin

This content originally appeared on Sugar-Free Mom. Republished with permission.

Au gratin means it’s covered with breadcrumbs or grated cheese and browned. The most popular high-carb favorite is potatoes au gratin. Obviously when you’re eating low-carb, white potatoes are not going to fit into your food plan.

My low-carb swap for replacing potatoes in this recipe is turnips. It’s the perfect low-carb veggie to replicate the size of potatoes as well as the color. If you’ve never tried turnips, I highly suggest this recipe!

If you dislike turnips, check out the original recipe to see what other low-carb vegetables you can use.

turnips au gratin

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Low-Carb Turnips Au Gratin

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This creamy and cheesy low-carb recipe will bring you all the comfort of potatoes au gratin with half the carbs!
Course Side Dish
Cuisine French
Keyword au gratin, turnips
Prep Time 20 minutes
Cook Time 1 hour 25 minutes
Total Time 1 hour 45 minutes
Servings 8 servings
Calories 319kcal

Equipment

  • oven

Ingredients

  • 2.25 pounds turnips about 6 medium
  • 1.5 cups heavy cream
  • 2 garlic cloves minced
  • 2 tbsp butter melted
  • 1 tsp salt
  • 1/2 tsp pepper
  • 2.5 cups shredded mozzarella cheese divided
  • 2 tbsp fresh thyme

Instructions

  • Preheat oven to 350 degrees F. Grease a 9 by 9 baking dish or 1.5 quart dish.
  • Peel the turnips and slice thinly about an 1/8th of an inch or use a mandolin.
  • Whisk together the cream, garlic, melted butter, salt and pepper.
  • Layer one third of the turnip slices on the bottom of the dish. Pour one third of the cream mixture over the turnips. Sprinkle a half cup of mozzarella over that. Repeat this process for the second and third layers. You will have 1 cup of mozzarella remaining.
  • Cover and bake for 1 hour and 15 minutes or until turnips are soft. Remove cover, sprinkle remaining cheese over the top and bake 10-15 minutes until cheese is melted and bubbling.

Notes

Net carbs: 7g

Nutrition

Calories: 319kcal | Carbohydrates: 10g | Protein: 9g | Fat: 26g | Saturated Fat: 17g | Cholesterol: 35mg | Sodium: 621mg | Potassium: 281mg | Fiber: 3g | Sugar: 5g | Vitamin A: 407IU | Vitamin C: 30mg | Calcium: 223mg | Iron: 1mg


Please note that the nutritional information may vary depending
on the specific brands of products used. We encourage everyone to check specific
product labels in calculating the exact nutritional information.

 

Low-Carb Turnips Au Gratin Recipe

Source: diabetesdaily.com

Realistic Goal-Setting and Avoiding Stigma: One Mom’s Perspective

This content originally appeared on Beyond Type 1. Republished with permission.

By Bonnie O’Neil

The title of the article arrests my attention, compelling me to read further. The Numbers of Shame and Blame: How Stigma Affects Patients and Diabetes Management. I shudder as I read the results of a study by the diaTribe Foundation. “Diabetes stigma affects 76% of people living with type 1 diabetes (T1D) and 83% of parents raising a child with T1D.” The statistics are so high.

Stigma. The word itself sounds uncomfortable on my lips. Diabetes stigma means carrying a sense of disgrace or shame because of having T1D, an unpreventable auto-immune disease.

I continue reading. “The majority of respondents who believe T1D is associated with social stigma identified the top three drivers of diabetes stigma — a perception of failure of personal responsibility, a perception of being a burden on society, and a perception of having a character flaw.”

I cringe as I read these findings. Does my son feel like he’s a failure when his blood sugars don’t cooperate and do what he wants them to do? Maybe he does. I know as his parent and caregiver I feel like a failure when his A1c isn’t what I had hoped it would be. Does he feel like he’s a burden on society? On his school? On his family? Oh, I hope not. I can hardly even reread that last driver of stigma on the list. Does he feel like he has a character flaw simply because he has T1D? My heart rises up to my throat.

How can I help my son navigate living with T1D in such a way that he doesn’t fall prey to the shame and failure associated with disease stigma? Rereading the statistics, I pause and ask myself another question. How do I as his parent carry disease stigma? The survey tells me 83 percent of us parents raising a child with T1D are affected by it. Am I a part of that 83 percent? When his physician suggests we make some changes to achieve better outcomes, do my reactions model for my son my own feelings of failure, guilt, or shame?

Whether overtly stated or simply implied, we all have goals in mind for our child’s T1D management. While I never announced my goals as clearly as I would my New Year’s resolutions, my son and I both knew what they were.

  • A1c at 7.0 or below
  • Blood sugars between 80-150
  • Not too many juice boxes in a day

Setting goals is important; it’s what keeps us moving forward as humans. During certain times of the year we’re especially focused on goal setting. Whether it’s January’s hopes for the new year, September’s back-to-school focus, or our birth month marking one more circuit around the sun, we can’t escape the human drive to set goals.

But in our best efforts to keep our child healthy and safe, how can we set reasonable goals that serve more as guard rails than leave us feeling stigmatized if the goals are left unmet?

Set Realistic Goals

It’s easy to slip from the hope and optimism of setting a new goal to feeling shame if those goals aren’t attained. Start small when setting new goals. Remember your child lives with this disease 24/7. Your eagerness to try a new approach to glucose management might feel like the addition of one more heavy weight placed on top of what your child is already carrying. Check in with your child. How does he feel about your goals? There’s a fine line between maintaining glucose control and contributing to diabetes burnout.

Hold Your Goals Loosely

Beware of the trap of stigma when we don’t hit our goals. Commit to living in the no-shame zone. The statistics reveal that 83% of parents raising a child with T1D struggle with stigma, meaning we parents struggle more with shame than even our children with T1D do. The next time you find yourself stressing over an unmet goal you have for your child’s care, recognize that the 83% is you. And it’s me. Let’s break the power of stigma in our own lives so we don’t model it and pass it along to our children. Offer grace to yourself and your child if the goals go out the window for a period of time. You can always get back on track once this season is over, so don’t buy into the failure narrative. Be good to yourself and to your child.

Be Aware of What You Reward

When my son was young, I would often take him to buy a small toy or gift after his appointments with his endocrinologist. It was a few years before I realized that I only bought him a treat when his A1c was at a level that met or surpassed the goal I had in mind. What message was I sending to my son? That I only reward what makes me proud? That my pride in him was linked to his A1c? Even well-intentioned gestures can leave our children feeling shame when they don’t reach our goals. Instead of rewarding only those times when the numbers match our goals, why not celebrate our child’s hard work and the joy of sharing life together after every appointment?

Watch Your Words

Goals like “Let’s do better with blood sugar control next year” imply a judgment that the past year was less than stellar. Your child (or you) may receive this message as a judgment that they (or you) were less than stellar last year. Words like better, good, and bad, which we use all too frequently when talking about blood sugars, are qualitative and can leave our child feeling stigmatized. Blood sugars and A1c’s are just numbers that provide us valuable information from which to make future decisions. Being careful with our language can help protect our child from carrying a sense of stigma.

Remember above all, our goal isn’t really about reaching blood sugar goals. Our goal is to build a healthy lifelong relationship with our child based on respect, encouragement, and love.

Source: diabetesdaily.com

New Target A1C Recommended for Youth with Type 1 Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Matthew Garza and Lydia Davis

The American Diabetes Association has lowered the A1C target for children to less than 7.0%, aiming to improve long-term health outcomes without increasing hypoglycemic events.

The American Diabetes Association (ADA) recently issued a new recommendation on A1C targets for children: youth with type 1 diabetes should aim for an A1C below 7.0%, rather than the previously recommended target of 7.5%. The ADA also emphasized that although this is a target for the general population of children with type 1 diabetes, it is important that each child’s A1C goal be personalized, taking into account hypoglycemia awareness, baseline A1C, and other health issues.

In 2018, the American Diabetes Association (ADA) reiterated its long-held recommendation that children with type 1 diabetes should aim to have an A1C of less than 7.5%. This target was designed to help prevent severe hypoglycemia (low blood sugar) in children. The ADA has revised that position in light of a recent review paper, which showed that elevated blood glucose levels can lead to significant complications during child development, including abnormal brain development, an increase in heart problems, retinopathy, and neuropathy. The review also showed that newer diabetes therapies and technology have resulted in a lower risk for severe hypoglycemia.

However, for certain groups of at-risk children, this new recommendation may not apply, and it may be safer to target an A1C of 7.5% or higher. Children with low hypoglycemia awareness, those who cannot alert others to symptoms of hypoglycemia, those without access to helpful diabetes technology (such as continuous glucose monitoring), and those who cannot test their blood glucose levels regularly should continue to aim for an A1C of less than 7.5%. Children with a history of severe hypoglycemia should aim for an A1C of less than 8.0%.

In contrast, children who are not at risk for hypoglycemia (for example during the often-experienced “honeymoon” period) should aim for an A1C as low as 6.5%.

The lower A1C goal of 7.0% will hopefully lead to a reduction in diabetes complications during childhood and throughout the lives of people with type 1 diabetes, without increasing their risk of severe hypoglycemia while they are young.

Source: diabetesdaily.com

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